Simultaneous atrioventricular node ablation and leadless pacemaker implantation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming . Objective We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes. Methods Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted. Results 33 out of 242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes. There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1) Conclusions Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run. In our experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance

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P1775Feasibility of concurrent leadless-pacemaker implantation and atrioventricular node ablation

EP Europace ◽

10.1093/ehjci/eux161.084 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii390-iii390

Author(s):

JL. Martinez Sande ◽

J. Garcia-Seara ◽

L. Gonzalez-Melchor ◽

M. Rodriguez-Manero ◽

XA. Fernandez-Lopez ◽

...

Keyword(s):

Pacemaker Implantation ◽

Atrioventricular Node ◽

Leadless Pacemaker

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073_16797-J1 Feasibility of Concurrent Leadless-Pacemaker Implantation and Atrioventricular Node Ablation

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2017.09.156 ◽

2017 ◽

Vol 3 (10) ◽

pp. S39

Author(s):

J.L. Martínez-Sande ◽

J. García-Seara ◽

L. González-Melchor ◽

M. Rodríguez-Mañero ◽

X.A. Fernández-López ◽

...

Keyword(s):

Pacemaker Implantation ◽

Atrioventricular Node ◽

Leadless Pacemaker

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B-PO03-038 PERMANENT LEADLESS PACEMAKER IMPLANTATION FOR LONG-TERM PACING DURING ACTIVE MRSA BACTEREMIA

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.514 ◽

2021 ◽

Vol 18 (8) ◽

pp. S204

Author(s):

Ashwani Gupta ◽

Muhammad Zubair Khan ◽

Steven P. Kutalek

Keyword(s):

Pacemaker Implantation ◽

Leadless Pacemaker

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Abstract 17088: In-Hospital Complications and Outcomes of Leadless Pacemaker Implantation: A Propensity-Score Matched Analysis From Nationwide Database

Circulation ◽

10.1161/circ.142.suppl_3.17088 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Moghniuddin Mohammed ◽

Amit Noheria ◽

Seth Sheldon ◽

Madhu Reddy

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Real World ◽

Electronic Device ◽

Artery Bypass ◽

Pacemaker Implantation ◽

Leadless Pacemaker ◽

Ventricular Lead ◽

Significant Difference ◽

Before And After

Introduction: There are no randomized controlled trials that compared the outcomes of leadless pacemaker (L-PPM) implantation with transvenous pacemaker (TV-PPM) and there is scarcity of data on real world outcomes. Methods: We queried National Inpatient Sample to identify all adult patients who had primary discharge diagnosis of conduction disorders or tachy-arrhythmias and excluded patients who had a concomitant procedure for valve replacement, coronary artery bypass grafting, ablation and/or cardiac implantable electronic device removal so that complications can be attributed to the pacemaker implantation. We included only procedures from November 2016 to December 2017 as Micra was the only available L-PPM during that period. For the comparison cohort we selected patients, during the same time period, who had a procedure code for single chamber pacemaker implantation in conjunction with right ventricular lead placement. We performed 1:1 propensity score matching and the variables used for matching are marked with asterisk in Table 1. All the codes used to identify complications has been previously validated from the Micra Post-approval registry and Coverage with Evidence Study. Results: Total of 1,305 patients for L-PPM and 13,905 patients in the TV-PPM group were included. Baseline characteristics with standardized mean difference before and after matching are shown in Table 1. Briefly, patients in L-PPM group were younger but had higher co-morbidities compared to TV-PPM group. The complications before and after matching are shown in Table 2. Conclusions: In conclusion, we found no significant difference between in-hospital complications after propensity score matching, with the exception of deep venous thrombosis. There was no difference between length of stay but cost for L-PPM was significantly higher. In this real-world analysis, we found that the leadless PPM implantation is safe in comparison to transvenous PPM.

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